[!TIP] mnemonic: 'flozins' are SGLT-2 inhibitors
Glucose 'flowz in' the PCT
| Agent | Class | Mechanism | Side effects | Other stuff | Expected effect |
| ------------------------------------------------ | -------------------------------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------- |
| Metformin | Biguanide | Insulin sensitiztion Reduce hepatic gluconeogenesis. | GI side effects Lactic acidosis (risk in renal/liver/heart failure – contrindications) No weight gain May reduce apetite, STOP when eGFR < 30 | Reduced GI B12 absorption The usual first line agent, can be combined with other | Lower FBS by about 50 mg/dL Lowers HbA1C by about 1% |
| Pioglitazone is the only one | Thiazolidinediones (glitazones) | Increases insulin sensitivity by binding nuclear receptors and altering gene expression may increase glucose consumption in muscle cells | no hypoglycaemia Commonly weight gain Fluid retention → precipitates Heart failure | May specifically benefit NAFLD | take up to 3 months to reach maximal effect. |
| Gliclazide Glimipiride Glibenclamide Tolbutamide | Sulphonylureas | Promotes depolarization of beta cell → stimulates insulin secretion (by binding ATP dependent k+ channel) | Weight gain! Hypoglycaemia | Effect will wear off with age as beta cell mass declines Risk of hypoglycaemia increases with age and intercurrent infection and duration of drug action Gliclazide / Glipizide / tolbutamide → Short acting Glimiperide → ? long acting but lower hypo risk Glyburide(= Glibenclamide) – long acting | Similar to metformin Weight gain of 1-4 Kg |
| Repaglinide | Meglitinides ("slp.ureas lite") | Post prandial insulin releasers (binds ATP dependent k+ channel like sulfonylureas) but act only for 3 hrs. So effective only in post prandial period when taken with meals | Hypoglycaemia Weight gain (but less than s.ureas) | Taken about 30 minutes before meals. | Less effective than other drugs. Role in DM Mx is not clear. Can be used with metformin is C/I or when patient only has post prandial hyperglycaemia |
| Sitagliptin Linigliptin | DPP-4 inhibitors (gliptins) | Inhibit GLP-1 breakdown (restore physiologic GLP levels) → promotion of insulin secretion GLP1 receptors are also found in the cardiovascular system | Good S/E profile. | Used as second line drug, in early DM when insulin secretion is still preserved. Combined with metformin / sulfonylurea | Modest effect but used because of low S/E profile. |
| Empagliflozin Dapagliflozin Canagliflozin | SGLT inhibitors | Inhibit the coupled reabsorption of sodium and glucose from the proximal tubules (+ other renal effects) | Dehydration Genital candidiasis (but not bacterial UTI),Can precipitate DKA (increase production of ketones) | Wonder drug! Decreases weight Improve renal dysfuntion – renoprotective Reduce atherosclerotic events! Reduce risk of heart failure | ?More potent glucose lowering than metformin(values given in K&C). Weight loss of 2-4 Kg over 1 year |
| GLP - Agonists - See Below | | | | | |
| | | | | | |
- *GI symptoms*
extrapulmonary manifestations:
Diagnosis: fastidious organism, use PCR
[!INFO] Ergot Vs. Non Ergot antiparkinson medications: Fibrosis Vs Non fibrotic
- Ergot derived antiparkinson medications: Pergolide, Lisuride, Bromocriptine and cabergoline
- Non ergot derived antiparkinson medication are the newer class: Ropinirole
- Others are pramipexole, ropinirole, rotigotine and apomorphine
- Ergot is a fungus which secretes psychoactive substances.
- Ergot derived antiparkinson mediations have increased risk of fibrotic reactions (pericardial, pleural, retroperitoneal) due to stimulation of serotonin receptors.
[!TIP] Mnemonic:
Ergot derived NON ergot Fungal PeLiCan B PramOnRottinRope Pergolide, Lisuride, Cabergoline, Bromocriptine pramipexole, ropinirole, rotigotine
[!INFO] See [[#Comparison of amoebiasis and giardiasis]] below
| Amoebiasis | Giardiasis | Cyclosporiasis |
|---|---|---|
| Protozoan | Protozoan | |
| Cyst is infective | Cyst is infective | |
| Cysts survive in environment | Cysts survive in environment | |
| faeco-oral transmission | Faeco-oral transmission | |
| Cysts resistant to gastric acid | Cyst resistant to chlorine | |
| Trophozoites cause disease | Same | |
| Invasive | Usually not invasive | Sporozoites invade small intestinal epithelial cells |
| Trophozoites localize in large intestine | Small intestine | Small intestine |
| Cyst ?immediately infective | Cyst immediately infective | Cyst must mature for days to weeks in environment -> human to human transmission unlikely. |
| Metronidazole / paromoycin | Tinidazole / metro | TMP + SMX |